1. Terrapinzflyer
    First free heroin clinic opens in Denmark

    COPENHAGEN — After years of contention, Denmark on Monday opened its first clinic equipped to distribute free heroin under medical supervision to people heavily addicted to the drug.

    The Scandinavian country joins a number of countries like Switzerland, the Netherlands and Germany to allow prescriptions for medicinal heroin, or diamorphine, to be written out to a small group of addicts so hooked on the substance that more traditional substitutes like methadone have no effect.
    The clinic is set to serve only 120 of some 300 hard-core heroin addicts, or only about one percent of all drug addicts in the country.

    "Our objective is not to cure heroin addicts, but to help those who are not satisfied by methadone by providing them with clean heroin, allowing them to avoid disease and the temptation of criminal acts to obtain the drug," a doctor and head of the clinic Inger Nielsen told AFP.

    Only addicts who have been referred from a methadone centre for treatment and who voluntarily request to enter the clinic will be permitted to participate in the programme, Nielsen said.

    They will be treated with methadone for the first 14 days "so we can determine how much heroin to prescribe," she added.

    The Danish parliament passed a law legalising the distribution of medicinal heroin in 2008, but the opening of the clinic was delayed until the city of Copenhagen agreed to house the programme.

    The User Association, a group representing drug addicts, remains critical, blasting that patients are required to go to the clinic twice a day, seven days a week, to receive their doses.

    "This means living like a zombie, without being able to hold down a job or study or have hobbies," head of the association Joergen Kjaer told reporters.

    Feburary 22 2010


  1. missparkles
    So what was this person doing when he was using smack...getting it delivered whilst he worked, or was that at his place of study? Jesus, are people expecting take away's too? Obviously this drug getting into an opiate naive persons hands is of no importance to him.

    Sorry, but I find this kinda attitude quite selfish. Eventually I have no doubt that people will be able to use this drug at home, but till the public get accustomed to the idea, it has to be this way. It's a big step forward, obviously some people can't see the bigger picture.

    All it would need would be for a few people to die from diamorphine ODs, and this project would be totally sabotaged. Finished. I give up. Sometimes I think that whatever measures are put in place it's never gonna be enough.

  2. moda00
    Yeah, the overdose/IV use is an issue. And health-wise, your veins would still become damaged over time causing riskier injecting sites, no? I can see both sides, I guess.. With methadone, there is no rush or high like heroin itself, or IV administration of any psychotropic; it is so long acting and little to no euphoria that after an induction of slowly upping the dose to stability, they can work people up to only coming in every few days to few weeks (phase system in US, unsure how this works- anyone know- in Denmark for MMT programs?) I still have plenty of complaints about the clinic system- see my journal/taper thread in R&A for a rant on this lol- but yeah, MMT here in the US does allow one to feel and act normal/sober- with the exception of the attendance requirements and spontaneous call-ins for med checks and piss tests as well as running into old using peers at the clinic when your lifestyle would otherwise preclude such contact. I think this needs to take place with an office-based physician after initial stabilizing, but overall it has benefits and seems pretty straightforward as maintenance and recovery if you utilize it appropriately (as anything it can be abused- but say more easily than naloxone or buprenorphine treatment, and less easily than something like heroin treatment, imho) and seems to allow the brain stability to work on the underlying issues that influenced one's addiction, but I do see some differences with this

    While I can see it would be good for them to be able to live functional lives with this as a prescription, especially if MMT is NOT working for them, I can't help but feel that the people for whom other long-acting opioid maintenance doesn't work are the people who are, for whatever reason, needing or wanting to stay in that addictive pattern of IV usage, the rush, etc. I also wonderpolydrug use is an issue, and if this is tolerated- MMT clinics test for most drugs, so while one could probably get away with some kinds of synth/RC or classic psychedelics on occasion if one desired, most commonly abusable drugs (most common combined with heroin, at least in clinics here, seems to be "speedballs" or crack or powder cocaine) I wonder he goal is abstaining from other illegal drugs with heroin prescription?? Again, with MMT, I think it can go either way- some people use it for harm reduction and find to continue their cocaine and/or weed habits while getting off their heroin addiction- which is still good in my book and harm reduction is important- but I think most people look to it as a stage of a full program of recovery- while I think one could still use certain substances and be in recovery, I do see a difference between continuing cocaine abuse/addiction alongside opiates, versus say smoking weed or doing psychedelics on rare occasions for the right reasons.. swim has not done so in a few years, but she doesn't think it would be wrong except in the sense that it would be wrong to do anything while breastfeeding or wrong to risk her legal status since she has a child depending on her, not worth it over some weed, nor worth losing her medication before she has finished a slow healthy paced taper.. but will thiescription heroin include things like recovery counseling, UAs and.or help getting off polysubstance dependencies like simultaneous cocaine addiction? It's just hard for me to see this as comparable to a maintenance program of recovery, as opposed to a harm reduction effort via clinics/prescriptions, or perhaps on the flip side, a novel prescription medication with one side effect being harm reduction in this population of users. I mean, I cannot say for sure and am aaking no judgments, either way I think it will have positive changes and effects- I am just interested to know how it is being promoted and approached, what the descriptions and motivations are for starting the program, and of the addicts who are referred to it.

    I just have trouble seeing this particular drug and mode of administration as conducive to functioning normally like on MMT or even like a time release morphine oral formulation which I think has also been shown effective on par with MMT (methadone maintenance treatment), but again I don't know, I know studies do show how it works in decreasing crime and disease and that is why multiple countries are implementing it, but it seems they still want the rush of getting high, and chasing a rush is a way to up the risk of OD, will these addicts be happy w/ a stable dose or will their tolerance go up and will they need or want dose increases to go with it? With methadone, your tolerance is supposed to level out, so you DON'T feel anything at all other than lack of withdrawal- you don't increase your dose in orr to keep feeling effects, kwim- again I don't mean to judge and am all for harm reduction and/or maintenance, especially in this case for treating addicts for whom nothing else has worked- but I do see the OD risk being huge with take homes due to the type of drug and mentality- the substance, mode, and ritual is identical to that with street drug heroin addiction except it is purer and measured better (talking take-homes) I (as swim a former addict) can easily see someone wanting to double up doses and chase a bigger rush/high.. maybe I am wrong on motivations or implementation, we'll have to see I guess..

    And, the point was made by a pp, I think Miss Sparkles, that these people were surely not able to hold down a job or family life beforehand, so maybe it is expecting too much that they will now? But to me, that is the difference of whether this is a program intended to minimize harms of injection heroin addiction, or whether the goal is a recovery process and integration into society, stopping other illegal drug use, etc.

    And part of me feels at confused and hypocritical, because I am getting to that point in my head where I think, I do not believe there is anything wrong with recreational drug abuse. And I also believe strongly that much of the issues of addiction come from prohibition- so in theory, this would be ideal- those who desire to can still get high couple times a day, but safely, not risking their financial future or credit or being thrown in prison or getting a disease or infection- that seems good, right? And part of me thinks that even in recovery, it is not wrong to want to alter one's consciousness, it is part of the human condition and I think can be compatible, and I do think this legal vs. illegal vs. different cultural/social norms thing has really skewed perception.. but on the other hand, I think people who have to be out of their mind high all day every day are usually NOT healthy and happy? That they often really in need of medical and psychological and/or psychiatric care for past trauma or abuse, low self esteem, coping skills, family problems, mevere mental illness, social ills like food insecurity, poverty, homelessness, etc. So part of me feels it is selling people short to say, well, it's all good,y can get high all day every day- because many of these people are probably really hurting. But then again i cannot assume that's true for all either- and I know myself and many others would actually NOT want to be part of society and hold a daily job and have a mortgage- many of us actually have the goal of living sustainably and forming intentional community and practicing art and music and reading and writing and talking and creating and cooking-- but is that possible, is there a place for that in this current world? So maybe that is the compromise some of these addicts make. And yes, I think swim and some of her friends who don't want to "grow up and join the rat race" would want to include some psychedelic exploration or use or marijuana or whatnot- but swim herself knows that addiction destroyed her soul and it is hard to tease out how much of that was its nature and how much was society' stance and impact and judgment.. but I don't think most people are or can be truly happy long term using large daily amounts of strong addictive drugs, but she doesn't know for sure.. I guess she thinks part of it also is that we chemically alter things- like opium or coca leaves, very different from heroin and cocaine. So maybe it is not the issue of daily substance use, it is the nature of the substances and the ABuse that comes with the potency and the nature of the chemical drugs we manufacture from the base plants? Maybe a bit off topic, I am just struggling with, assuming this program has a different goal from say MMT, which is to totally change one's estyle and coping skills and drug use, stabilize, and eventually taper off that too- versus, if this is the case, a program that simply provides a prescription so that people are not stealing money or having health problems from street drugs to which they remain addicted? And is either really right or wrong? I mean, don't get me wrong, swim is very grateful that stabilizing on MMT allowed her life to be sred and her to make changes and get where she is today- she does not want to be an addict and slave to heroin again- but she also doesn't know, had MMT NOT worked, if she'd have rather died, or stayed a heroin addict for life but needing to go to a clinic to get it- I mean, good things- free, safe, clean- but, yare still a heroin addict whose life revolves around it, same lifestyle, and the key question to me is, how does this play out for those in the program? Are ngs like housing, counseling, other medical issues addressed or is it a single aspect program? I know it is oft better to address one issue and address it well and thoroughly than to try and fiit all when you realistically cannot. I also know Denmark has a different social and governmental structure and policy than the US so maybe cannot compare the two.. but feel a bit hypocritical to even dare to criticize this program if its aim is not recovery- i guess i am asking, is it fair to assume that everyone WANTS what we would define as full standard recovery, and what goes with that? Or that everyone is capable of attaining that? I don't know the answers...

    Again, I would love to know more about how this plays out, what the goals and motives and responses are, as I am admittedly ill informed as to this specific program and will be doing more reading on this, and like I said I may have some misconceptions- I understand heroin Rx programs are considered as or more effective than other opioid scripts for reducing crime and spread of disease, ill health/infection, abscesses, that kind of thing, but are they still getting a rush or chasing a high? And is that bad? One point I often make when trying to educate people about methadone maintenance is that on a proper dose, there is no euphoria, analgesia, physical effect, or psychoactive effect, and one has complete tolerance. But I do think even in mmt there are a few people who abuse the system by increasing their dose above a stable level (though the docs will not generally allow this to happen often, as they monitor this), or doubling up take-homes, or still using other psychoactives or even other addictions that are non-opioid- is this wrong? I guess it comes down to, the harms on others and society have to be reduced, and if an individual is being harmed, one would assume would want to address that if they are genuinely being harmed. But I guess for example I think "100% sober recovery" is overrated, even though personally swim is glad to have had extended time of sobriety, to have worked extensively in group and individual therapy on her underlying issues, to be able to support others in recovery; it's been good for her. But it also be bad- for example, when it is all or nothing and it drives people away- when someone wants off hard drugs but wants to smoke pot and is kicked out of their program, or when someone relapses and the same happens? This does more harm than good.. so part of me thinks, prescription heroin will solve certain problems, but unless they are at least OFFERING additional services, like referrals for other addictions and drug abuse, counseling, psychiatric referrals for mental illness, housing help, etc. then they are not giving these people a real shot at recovery. But on the other hand, some of these people may only want or need the harm reduction of this program and have no intent on some of the things recovery might entail, like regular meetings with a counselor or doctor, therapy, quitting other drugs or getting urinalysis, following through on job opportunities and government programs, etc. then that is on them. I guess a big question is what is available, versus what is mandated, and how n addicts tailor a program that meets their needs? What are their goals? Do any of these programs allow take-homes/phase progression like with MMT in the US, so they aally would have a chance at holding down a job or college schedule? How is dose determined and are these addicts eligible for disability or other services or is the goal for them to use iv heroin AND reintegrate into society? I would also be interested in knowing the demographic as far as age, socioeconomic and housing status, family status, income, addiion and AODA history, etc.

    I know one can iv heroin and function, but as an addict, swim was always pushing boundaries- not just wanting to maintain, but wanting to be as high as possible- leading to escalating dose, nodding, and overdose. So, it will be interesting to see how it plays out and will have to check out some other research on how this will work, or has worked in prior studies.

    Mentioned a bit through the post and some of you all know me, but full disclosure, swim is a heroin/cocaine addict in recovery, no coke in 4 years, no heroin in about 2 years plus a few odd months; she gets that there are treatment-resistant addicts, and clean pharmaceutical diacetylmorphine and paraphernalia at affordable prices/free is so much better for the health and lives of these addicts, but herself, she thinks that the whole ritual of IV use, the underlying issues for herself and that seem common in treatment-resistant addicts, the immediate mode of IV administration, rush, bio-availability- of course who wouldn't want that feeling as an addict, and there is nothing wrong morally with feeling euphoric/goodithout ill effects- fear of not getting next fix, cost, legal issues- all of which are avoided with this new program right? Swim cannot recall exactly, but I suppose there had to have been a time early in her use/abuse when she could inject heroin (and sometimes coke along with), get the rush and high, and function fine at school and work, but yeah, if drug itself did not interfere, then the clinic attendance thing twice daily sure would.. and again if factors like homelessness, poverty, hunger, pression, PTSD, abuse, etc. play into it (thinking back to the "untreatable" or treatment-resistant population of addicts in the book I reviewed a couple days ago, Hooked) then are these issues also addressed, or were they addressed in earlier tx attempts? Had they been addressed, could another treatment mode have worked? I guess for swim, luckily, she was almost one of them (an addict for whom treatment options all failed- "treatment-resistant") but the final try, the last option legally available to her in her country, was the one that worked, the methadone, and she also had health insurance for good group therapy and individual counseling etc., payed for the meds, had food and housing and transport, etc. So it makes swim think there are many issues perhaps intertwining. But I don't know, I guess in some ways it is not fair that some people would just hang out and get high for free and others have to work, but nothing about the "system" is fair in my eyes, capitalism, democracy, it does not work like it should, so who am I to judge, and again, I don't know how this is all addressed in the country in question.. I guess I just feel like MMT does not cause any relevance to the highs/lows/feelings associated with opiate addion via IV heroin (and sometimes IV cocaine too) and she just feels "normal" no itchiness, sedation, pinned eyes, whatever from opiates-- though she is actually tapering off of it now, so she does have some withdrawal effects when adjusting to another decrease in dose as she is now-he is just intrigued to see whether this approach is more harm reduction or recovery based/maintenance, not that one is morally superior, they just seem to be very different from what I know, as mmt is focused on getting therapy to address root issues, balancing things like school, work, finances, social and family relationships, legal obligations, etc. The dose is so long acting and taken orally that swim has not once had an inclination to take more than prescribed or abuse or sell it, it just does not even feel like the same type of drug she had an addiction to, and maybe it's mindset rather than pharmacology, but I do see pharmacological advantages to using long acting opioids for opiate maintenance and look forward to seeing how this works.. I am all for innovative methods though, especially when others fail, because clearly prohibition has failed, many drug treatment efforts have failed, we have to try new things and reduce harm and help people however we can, so I am all for good intentions and doing what has to be done to minimize ill effects.

    Well that was a long ramble, but I have long had questions and thoughts on maintenance for opiate addiction (and possibly the concept with other drugs like stimulants) and w heroin being prescribed to addicts in several countries now, I think it is really important to investigate not only the fact that, yes, it works in reducing crime and health problems, which makes clear sense, but in thinking through our own attitudes about addiction, recovery, morality, legality, etc. And in figuring out what makes a program a success, who defines such, who sets the goals, what are the motives? Is there a line of hypocrisy somewhere in our perception of this? I look forward to reading more on this issue, love to hear others comments or any more links about this project..

    I wonder what she means? Obviously that the goal is not to get them off heroin- whereas with methadone, at least here, it is ambiguous- they offer a short-term detox or longer-term maintenance as the two choices at most clinics where swim is, and when on the maintenance, they usually say that stabilizing for a few years is a good leh prior to taper attempt, but also that some people stay on for months, some for years, some for life, that there is really no set goal other than the client's readiness and their own goals and need.

    But I would like to know by "cure" (I don't think addicts are ever cured in a true sense, just that they are in "remission" of sorts; what I'd call long-term or stable recovery) if she means that the sole goal is to prevent the harms associated with the use of illegal/street product (which is admirable in itself) or if, more like mmt, they want to have them hold jobs, earn money, all that jazz.. I imagine that despite the indignation over the period of twice daily attendance, well, it's short acting, and with methadone it is once daily for at least a few months- I agree that they can't have ODs on their hands- though it's all politics, since addicts OD every on street dope, probably more likely even though I cannot prove it, just because purity/batch can vary unlike pure pharma stuff.. but I can see why they would want to observe to revive ODs, ensure not mixing drugs, etc. I still want to know to what extent other measures would be put in place if any, and who determines what the goal is (if it is stated to not be an obvious "cure" which we could surmise given the nature of addiction)
  3. missparkles
    To be honest, I think that prescribing diamorphine as part of a harm reduction treatment regime is an excellent idea, cos it's about keeping people alive for long enough so that hopefully, they will eventually quit. But harm reduction has gotta come from both sides. You can't expect governments to Ok this form of treatment on the grounds of "harm reduction", then take ridiculous risks with you own health by using other substances in tandem with diamorphine. Either it's harm reduction or it's not.

    I also think that telling people that they are never gonna get off drugs, which is why they are being prescribed this treatment, is also extremely disabling. Telling them, "here have diamorphine, cos you incurable" is like giving up on them. And as has been said already, the idea behind methadone is to stop you getting sick (which was the reason most addicts gave as the reason they had to use) not to get you high. Cos quitting drugs is not just about putting down the drug.

    It's about changing the thoughts that accompany using. The need to get high to live and cope with daily life. And again, methadone allows you to get outta that "chasing the high" loop. It allows you to get into a routine where you prove to yourself (by actually doing it) that it is possible to get through anything without using.

    Cos that's what addiction is about, the belief that you really can't function without a high. But that's a fuckin' lie, cos everyone can. Heroin addiction warps perceptions, makes people believe they can't manage their lives drug free. Now if people just don't wanna quit, just wish to get high...fine, I have no problem with that. But the dishonesty surrounding this controversial programme is what I do have a problem with.

    Sparkles smokes, she did wanna quit. But she couldn't. Now she realises she just doesn't want to, she enjoys smoking. Yeah, sounds suicidal, but she's just being honest. Now, when she was using, it was the same. Yeah she had problems, but none that were unsolvable. She enjoyed the buzz...simple as. And until the pain she experienced outweighed the pleasure of the high she was gonna keep using.

    Now perhaps the shit that addicts go through is part of the process? Make it too easy and no one will ever stop. No, I'm not advocating making addiction difficult, just advocating not making "keeping your habit" too easy an option. Big difference.

  4. mickey_bee
    The point he's making is that this program, which in itself has been set up to improve the lives of those heavily addicted to heroin, is in fact still seriously hindering their re-integration into, 'normal' society.

    Obviously, at least in the UK and US, all it would take would be for a couple of people to OD on pharmaceutical heroin,(as opposed to the hundreds who die each year as it is), and there would be a media uproar, and strong pressure on the government to close the clinics before they've really been given a chance to show what they can do.

    That's just the way it is, people, en masse, are stupid, and only accept little changes a little at a time......when what is actually needed is radical policy reform.

    Swim has read up about the Danish Users group, and they do actually do things, it's a sort of commune for addicts, (but not in your traditional sense), it's a clean, well-managed, safer, and more proactive environment for the addicts to live/work in. It's quite interesting.

    The same thing happens in the UK with the RIOTT program at the moment. Swim know's two people who go there for supervised diamorphine injections. One goes 3 times a day, the other has reduced it to twice. Don't get me wrong, it has helped their lives dramatically no longer needing to use street gear, particularly as one of them IM's his shots due to lack of veins-an impossibility with street heroin.
    Despite this, while they're no longer out commiting crimes everyday, and begging up every penny they can, they're still living in a limbo, where they have to report back to base 2 or 3 times, every single day.

    It's impossible to go on anywhere with your life when you're forced to do that. Certainly impossible to pursue work, or other interests.

    The argument of, 'oh yeah so I bet that's what you were doing while you were on street smack' is a pretty infantile one.

    This isn't about then, it's about now, and trying to improve these people's lives.
    Swim's an IV heroin addict who does ~1 gram of street heroin everyday, alongside being forced to go to a methadone clinic 6 days a week. At the same time, swim works, and is in his second year at university.
    It's f**king hard, and it would be so so so much easier for people like me, if the public could accept that no benefits will realy be obtained until the stringent rules surrounding dosing are relaxed.

    Swim's methadone clinic is only open between 10am and 3pm. As a result of this, at least twice a week, swim has to decide between picking up his methadone, or going to work/university. It's literally crippling.

    Yes, funding the gram a day is also crippling, but this isn't supposed to be another hurdle, this is supposed to be a help, a form of relief, escape from that lifestyle!!
  5. moda00
    Yes, swim is to once weekly dosing with methadone and that is (hopefully) where she'll stay till she is (hopefully) off it. It's only open from 5:30-9 am, and with a sleep disorder and a baby, it can be damn near impossible to get there, and if she misses her day she is in withdrawals that day (rapid metabolism/12 hr dosing, though she does take home her 2nd dose on the day she goes) PLUS one day a month minimum when they call you for a random urinalysis and check your doses are still how they are supposed to be i.e. not all used up already. It is degrading and interferes with life, and compared to the people on most other phases who have to go more often, and/or people on a program where take-homes will never be an option (like, it seems, this diamorphine program??) one can never live a life where their physical and mental status are separate from their addiction issues, they will not be able to travel or do school/work or have any level of discretion ("uhh I have to go now or i'll be late picking up my heroin" ?? um nope...) and you nailed it in that, street users have many more health problems and overdoses but this program will or would be crucified if there were even one or two overdoses from the diamorphine they provide- the point is, addiction is addiction and people who want to abuse any street or rx drug will, we can provide tools to better lives (and like i said, i do sort of like to think this program would also be more like an mmt program where the goal is to stabilize the brain and remove the fears of withdrawal, arrest, etc. so that the person can work on their other issues..) but i can see miss sparkles that assuming these people will never get better is not a helpful approach at all- although translation may be an issue, "cure" can be interpreted differently (like i said, i don't think addiction can be "cured" but i think ACTIVE addiction can be put into recovery or remission) and so i certainly hope that is the goal-- but on the other hand, there may genuinely be some people who, as you say, don't want to stop, and i would hope harm reduction would still be available to them too, since otherwise it becomes a moral thing, and if you are not ready to stop right away i believe one should still be entitled to harm reduction to hopefully plant that seed and to keep people alive and healthy until they DO get to the point when they are ready for recovery.. a lot to think about here, thanks for the good comments and responses, keep 'em coming :)

    does anyone know, pharmacologically, if it is possible to have a stable level of diamorphine like it is with oral methadone maintenance, to the extent that cycles of being really high and withdrawing could actually be prevented (i assume that is the goal to some extent??) are there blood tests or other factors (evaluation of appearance, functionality, etc.) used like in mmt (peak and trough, evaluation by clients and clinic staff, etc.) to see if the dose is right? i just don't know much about heroin in this context and wonder how it works- as mentioned, intramuscular injection of a pure pharmaceutical product could well be the answer to help with a slower steadier release, minimizing problems like vein damage, and causing more stable maintenance.. that is one idea.. i wonder how they plan to implement it- i.e. is it like the safe injection site in canada, where they are overseen by a nurse and given clean equipment and privacy, narcan if needed of course, but instead of bringing own street drugs, they are thus provided with a specific accurately measured dose of pure substance instead? i would absolutely love to see a documentary on this (anyone know of this?) or read a book tracking the implementation and experiences with such a program.. this is a fascinating idea to swim as she has a strong interest in all aspects of opioid dependence, addiction, recovery, treatment..

    Interested to here more about UK's RIOTT program mentioned too, if off topic for this thread maybe pm me and/or link to some other info, or I'll do a search when I get a chance today or tomorrow (gotta get up early tomorrow so I should get to bed here) anyways, will be interesting to compare and contrast the motives and implementation of such programs in existing areas with a new start-up like this in a new country, and evaluate how certain cultural or socio-economic factors influence the similarities, differences, and oversight in these types of programs.. can't wait to see how this plays out..

    The article says that the mmt clinic they currently attend, in addition to the patient themselves, must refer them to this program, and that only a portion will get in.. Is it a pilot program to start out for a limited time before expanding? A funding issue? A study being done, with a need for control subjects (though obviously they won't be /are not randomized..)? Anyone know or did I overlook this in the article?? I wonder, what is the reason for only some addicts having access???
  6. missparkles
    I think the reason methadone doesn't work for some is because it lacks the high they crave. Diamorphine gives you that high. But doing any studying, work, in fact anything that requires any level of consistency, is virtually impossible. Just think about it, that high makes everything seem ok, life and it's problems just melt away. That's just totally unreal. Life keeps going, just cos you stop for a couple of hours, it makes no difference. On methadone it is possible to stabilise, on diamorphine it's not, but it is possible to use in a safer way. You can keep people safer till they get to a point where they may decide to quit. And most do.

    On paper or in a debate these are all fine sounding ideas, but in practise this just ain't gonna work. And where does it end? Should we start handing out booze to alcoholics at set times per day, just to keep a specific amount in their bloodstream, but to reduce their need to get drunk? OK, this might sound bloody ridiculous, but can you see where it might lead? If people want to get high, I believe they should be allowed to, with minimal risk. But lets not call it harm reduction. Cos if you want to take a drug that could stop you breathing, damages veins and has all sorts of associated health risks, then calling it harm reduction is hypocritical. Cos you're enabling someone to cause themselves harm, harm reduction becomes a sound bite, just spin. Again I have no problem with this, just let's be honest about it. People dislike methadone cos it doesn't have the euphoric rush that heroin has, and that's what the addict is looking for. Not recovery. If they wanted recovery they'd take methadone.

    Another worry I have is what about people who smoke, should their chronic addiction be treated any differently? And if it is, wouldn't the number of IV users rise? Giving an addict diamorphine is almost an admission of defeat. You're so damaged there is nothing we can do for you. Like palliative care. Maybe that's the idea, throw drugs at an addict and let them kill themselves. That's also a commonly stated opinion that I've heard frequently.

    Sparkles was on a diamorph script and all of her mates eventually ODd, not cos of diamorphine and it's purity, but due to poly drug use. That's the reality. Even the research (undertaken so far) says that people still use other drugs whilst on diamorphine. That's not harm reduction. That's enabling. I believe giving people no hope, cos telling them they can never be cured is actually disabling them. Now if this money was spent on social issues, like making sure people have nice homes, education options, and jobs when they quit drugs, more people may be able to stay drug free. Educating the public about what causes people to need drugs, to be understanding of them, will also help. The people I talk to (personally) who say it's going back to the "old" life that prevents them from staying clean.

    Their social situation remains unchanged, so they do what they know to survive it. Their childhood was awful, so they took drugs to escape the feelings. So help them to deal with this. Cos until we stop seeing this problem as a personal failing, as opposed to a cultural/global failing, it's never gonna change. We are all responsible for each other to a certain extent, and until we start to help each other there will always be people who are gonna die from addiction.

    I know this idea is gonna be unpopular. But please don't think I'm judging anyone, cos I've been there, and as such I know how it is. I'm just being honest. I can't be any less. Just want to point out that this is an opinion, nothing more. So lets keep it friendly.

  7. Spucky
    AW: First free heroin clinic opens in Denmark

    Ever journey starts with a first Step!

    ps. many People don`t like the "Full-synthetic Diaphin",
    it`s not delivering the Relief addicted People are looking for!
  8. dyingtomorrow

    Your arguments seem to be based on the premise that all heroin addicts are people who use drugs to blot out a traumatic event, or accidentally got addicted but could otherwise be happy people. I agree that permanent diamorphine would not be the optimal solution for people like this, but you are forgetting another major cause of incurable heroin addiction.

    Granted this is just SWIM's personal experience, but in his time wandering around the ghetto and grouping up with homeless heroin addicts, it seems the vast majority of these people are schizophrenics, bi-polar, or severely mentally disturbed because of biological causes. This is sort of accepted as a general truth by the psychiatric community, although not that loudly since nobody wants to admit that illegal drug use is anything other than a malicious choice. Most of these people have been miserable and tormented their entire lives, and put on every kind of bullshit pharmaceutical drug that psychiatrists prescribe that doesn't do shit to help them. I've seen so many schizophrenics who go from twitchy, disturbed and out of their mind to completely lucid and normal seeming with a shot of heroin.

    After trying something that makes them feel like a happy, normal person every day, as opposed to the offer of living a miserable, depressing, zombified life on horrible psychiatric drugs, what the hell else are they going to do. I think it is as close to a fact as you can get, that someone who has had severe emotional and cognitive problems their entire life deriving from bonafide psychiatric issues, who has tried heroin and experienced the 100% relief it gives, is NEVER going to truly quit. These are the people who, at the very least, should get heroin prescriptions. Of course, it is not only these people who have very little chance of getting off heroin, but they seem to be a very clearly and (grudgingly) socially admitted incurable cross section of heroin addicts. Society would be much better served by giving them pharmaceutical heroin, while also doing whatever possible to see none of it is diverted.

    I'd add one final thing.

    For most addicts, it wouldn't even need to be heroin to help them. Methadone is just not a very good substitute for, I am confident in saying, most people. Some people are happy with Methadone, but whereas most opiates seem to give stamina, happiness, and inspiration of sorts, Methadone for many people makes them perpetually tired, depressed, slovenly and lazy. The closest feeling drug I can think of to Methadone is Lithium - just a terrible thing to be on.
  9. missparkles
    I totally agree with everything being said. And addiction is difficult for anyone to deal with, especially when mental illness is also a factor. I'm not assuming that everyone has suffered some trauma that causes their addiction, far from it. I'm saying that whatever causes addiction, be it trauma, mental illness or just rec use that's got out of hand, that throwing a drug at the problem is just not the answer. There has to be other things put in place. Cos just as refusing a drug doesn't solve the problem, neither does just handing out heroin.

    Now it might be part of the solution, but it can't be seen as the only one. And that's the impression I get from the people I speak to. They believe that once they get a diamorphine script their troubles will be over. That's just not true. Most people who become addicted to heroin will experience health and social problems connected to their using. This on it's own can affect how they see themselves. The negativity of their addiction has them believing they have no choice.

    Some people, especially those who have underlying mental illness issues can't be treated with just opiates, that's like saying "let's just get them wasted, that way they'll be happy, then they have no problems." Well they've already tried that, and it hasn't worked. Anyone with a mental illness who is addicted to drugs doesn't stop being ill, they're just using an alternative drug is all. After all, if using opiates worked their illness would disappear wouldn't it? So that obviously is not the answer.

    And how do doctors identify who is suffering from emotional problems which may have been caused by their addiction, and people with mental illness? The point I'm trying to make is that opiates might be a solution, but you have to look at social circumstances too. What's the point of treating a person according to symptoms if you don't address the causes? It's not just about drugs, it has so many levels. But the attitude that seems to prevail is that you give a junkie drugs and all their problems are solved.

    I'm saying this isn't so. If after exhausting every other option there is still a problem then by all means offer opiate treatment. But hell love, why condemn people to a life of addiction just because you can't be bothered to use the time, money and resources to find out what's really gonna help?

    As far as trauma being the cause of addiction I doubt it is the only cause. Sparkles didn't use drugs cos of her childhood abuse, she used drugs because she suffered with PTSD and a borderline personality disorder, both of which are classed as mental illnesses. So please don't tell me I don't understand cos I've spent 30+ years fighting demons, my own.


    DT, haven't we been here before love? :s

  10. dyingtomorrow
    All any drug does besides antibiotics is treat the symptoms, and opiates seem to be a million times more effective than anything else they have for a lot of severe mental illnesses. I think if you took someone who broke their spine, didn't allow them any effective medication for the pain, and then introduced them to street heroin as they only thing they could get that helps, well there you'd have someone spending all their money for relief until they were broke and homeless too. Physical pain is not the only kind that requires drugs. No amount of psychotherapy is going to help someone with severe mental illness. So you can't exactly call the painkiller the reason for their problems, rather it is the lack of an effective available painkiller, and social punishment for taking the painkiller, that causes the problems.
  11. missparkles
    Thing is, this is not about a physical pain, it's about a treatment for addiction, but I do get the point. I think it's sad that anyone should suffer with just one alternative, no other options available.

  12. moda00
    Thank you- it is interesting to have some more info and some perspective from a person who has been there.

    Well said.

    (bolding mine)
    Exactly. This can be a step if nothing else is working to minimize harms and maybe keep people alive until they are ready or able for true recovery-- but just the drug provision, without OTHER THINGS being put in place to address the huge societal issues, will not solve the problem.

    The recent book I reviewed discusses this in depth and thus I've been thinking a lot about it lately- whether harm reduction or treatment attempts or whatever, just addressing drug use in some way, or providing a drug, needs to be supplemented with help with poverty, mental illness, homelessness, coping skills, counseling, etc. Those things, I reckon are at least if not MORE important than addressing the drug abuse/addiction.
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